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RBG, PEORIA - FORMS
PRINCIPAL FINANCIAL GROUP RELEASED DOWNLOAD
Employer Enrollment
CENSUS ENROLLMENT AGREEMENT
4/29/2014   Download
EMPLOYER ADMINISTRATION GUIDE
2/17/2015   Download
EMPLOYER APPLICATION

Description:
Master Application for Group Insurance (pdf , 208k)

4/29/2014   Download
Employee Enrollment
2015 CONVERSION LIFE APP
4/10/2015   Download
2015 CONVERSION LIFE INSTRUCTIONS
4/10/2015   Download
AUTHORIZATION FOR RELEASE OF INFORMATION

Description:
Form signed by employee if other carrier apps are submitted (pdf , 90k)

1/28/2014   Download
BENEFICIARY CHANGE-DESIGNATION FORM
1/28/2014   Download
EMPLOYEE CHANGE FORM

Description:
Employee change (pdf , 292k)

1/28/2014   Download
EMPLOYEE ENROLLMENT FORM

Description:
With Statement of Health (pdf , 676k)

4/29/2014   Download
STATEMENT OF HEALTH

Description:
UW additional medical coverage (pdf , 184k)
Version: GP46194-3

2/17/2015   Download
VTL CONVERSION APP
4/10/2015   Download
Administration
CENSUS ENROLLMENT SPREADSHEET
5/6/2014   Download
CENSUS TEMPLATE FOR QUOTING
2/12/2015   Download
COBRA NOTIFICATION/ELECTION FORM
1/28/2014   Download
CONTACT LIST
5/6/2014   Download
EMPLOYER CHANGE FORM

Description:
Administer Employee Changes (pdf , 165k)

1/28/2014   Download
FIELD UNDERWRITING QUESTIONS
5/6/2014   Download
NEW ELECTRONIC SERVICE AGREEMENT
5/6/2014   Download
RISK APPRAISAL QUESTIONNAIRE (RAQ)

Description:
For 51+ groups, please speak w/RBG rep prior to completing. Specific requirements must be met. (pdf , 183k)

5/6/2014   Download
Claims
DEATH CLAIM FORM
4/10/2015   Download
DENTAL CLAIM FORM
1/28/2014   Download
DISABILITY CLAIM FORM
1/28/2014   Download
LIFE CLAIM FORM
1/28/2014   Download
MEDICAL CLAIM FORM

Description:
Claim form (pdf , 211k)

1/28/2014   Download
Rx CLAIM FORM

Description:
Prescription Claim Reimbursement (pdf , 0k)

1/28/2014   Download
Other
Broker Access - eFP

Description:
How to register & activate your account to access your employer group information (pdf , 43k)
For more information: Click Here

12/11/2009   Download
GROUP PRODUCER SUPPORT CENTER

Description:
contact list for agent/group (pdf , 38k)

1/28/2014   Download
NON MED PRODUCT GUIDE

Description:
Includes guidelines, participation, and other helpful information for the non med products (pdf , 528k)

1/28/2014   Download
VISION DISCOUNT PROGRAM

Description:
Available program for groups that have other lines with Principal (pdf , 146k)

1/28/2014   Download
VSP FLYER

Description:
Value added program: Vision Discount Program (pdf , 146k)

1/28/2014   Download